Graves’ Disease Across the Life Span

Graves' disease usually starts in adulthood, but children can develop it, too, most commonly around age 12.

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Graves’ disease is an autoimmune disorder that causes hyperthyroidism. In the United States it is the most common cause of hyperthyroidism, affecting roughly 1 in every 200 people. (1)

Most people who have it are diagnosed in early to middle adulthood. But children and older adults can also develop Graves’ disease.

Although most of the symptoms of Graves’ — including a fast heartbeat, insomnia, hand tremors, and weight loss — are similar throughout the life span, a person’s developmental stage and other medical conditions can mask the presence of Graves’ disease or make it more likely Graves’ will be mistaken for another condition.

Graves’ Disease in Children and Adolescents

Graves’ disease occurs much less frequently in children than in adults, at a rate of 1 in 100,000. It very rarely develops before age 3 but becomes more common as children approach puberty, with 12.5 the average age of onset for children. (2)

Girls are four times more likely than boys to have Graves’, and children are more likely to develop the condition if they have a history of hyperthyroidism in their family. The most common co-occurring conditions in children with Graves’ are Down syndrome, type 1 diabetes, asthma, and vitiligo.

Roughly half of children with Graves’ disease will experience an eye problem called Graves’ ophthalmopathy. They may have bulging eyes, blurred vision, or appear to be staring. Most symptoms of Graves’ ophthalmopathy can be relieved with eye lubricants.

Treating Graves’ disease early in children is important, because as children approach adolescence, Graves’ can interfere with puberty and physical development. Ideally, children with Graves’ disease should be seen by a pediatric endocrinologist for monitoring and treatment.

At puberty, girls with hyperthyroidism may experience irregular periods, (3) and teens of both sexes often have such symptoms as weight loss, lack of energy, blurred vision, attention problems in school, palpitations, mood swings, trouble sleeping, and intolerance to heat. Parents sometimes fail to recognize these as symptoms of Graves’ disease and instead believe their child has attention deficit hyperactivity disorder (ADHD) or a substance abuse problem. (2)

But parents should not assume their adolescent’s symptoms or behavior are due to a thyroid problem without consulting the child’s doctor.

Treatment for Children and Adolescents

Treatment for children and adolescents with Graves’ disease usually begins with antithyroid medications (ATDs), which block the thyroid gland’s ability to make thyroid hormone. The drug Tapazole (methimazole) is more commonly prescribed for children than propylthiouracil, because the latter may cause liver complications. Children and teens may be more likely than adults to experience side effects when taking an antithyroid medication, such as rashes.

If your child develops a sore throat, mouth sores, or fever while taking antithyroid medication, report it to the doctor immediately. These symptoms may mean that your child’s white blood cell count has dropped, lowering his resistance to infection.

Children experience a lower remission rate when taking ATDs compared with adults, and the best results are often achieved after they have taken antithyroid medications for many years. (4)

Older children and children who experience reactions to ATDs may benefit from switching to treatment with radioactive iodine therapy (RAI). But RAI often causes a person to develop hypothyroidism, requiring him to take thyroid medications for the rest of his life.

Surgery for hyperthyroidism is less likely to be recommended for children, because anesthesia can pose greater risks for children. Your child’s doctor or surgeon may also discourage surgery as an option because of the risk of damage to the vocal cords or the parathyroid glands, which control the body’s calcium levels.

Graves’ Disease in Young to Middle Adulthood

Graves’ disease is most often diagnosed in people between ages 30 and 50. (5)

Pregnancy may trigger Graves’ disease in some women. Roughly 1 in 1,500 pregnant women will develop Graves’, and as many as 30 percent of young women with Graves’ disease were pregnant in the year prior to the onset of their symptoms.

Severe stress or trauma may trigger the onset of Graves’ disease in adulthood. For people who have already been diagnosed with Graves’ disease, additional stress can also cause symptoms to worsen.

Treatment options for young and middle-aged adults generally include antithyroid medications, radioactive iodine therapy, or surgery.

“Generationally, people think differently, and one of the major tenets of treatment is that patient values and preferences should help with the decision as to how you’re going to treat this disease,” says Douglas Ross, MD, a professor of medicine at Harvard Medical School and the codirector of Thyroid Associates at Massachusetts General Hospital.

“My experience has been that most of the millennials don’t want to have anything to do with radioactive iodine. But I think there are also differences across the country and in academic centers as well,” says Dr. Ross.

Graves’ Disease in Older Adults

Roughly 0.5 to 4 percent of older adults will develop hyperthyroidism. (6) Most will have the same symptoms as younger adults, including tremors, anxiety, palpitations, weight loss, and heat intolerance. But some have few of the classic symptoms of hyperthyroidism, potentially leading to a delay in diagnosis and the initiation of treatment.

Some of the more common symptoms of Graves’ disease among older adults are weight loss and shortness of breath. (7) The disease can accelerate the rate of bone loss in older adults, leading to osteoporosis and broken bones. Women over the age of 65 with hyperthyroidism are three times more likely to fracture a hip and vertebrae.

Treatment for older adults with Graves’ disease will depend on the health status of the individual as well as whether the person has any co-occurring health conditions. Radioactive iodine therapy can be a good option for older adults, although 80 percent of those who use it will eventually develop hypothyroidism and need thyroid hormone replacement therapy.

Antithyroid medications can also be prescribed to treat Graves’ disease, but older adults may be at increased risk for side effects, such as a lowered white blood cell count.

Surgery is also a less commonly used option for older adults because there is an increased risk of complications, especially for those with other health conditions. If you’re an older adult with Graves’ disease, talk to your doctor about the best treatment option for you.

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